Three Things You Should Know About ICD-10

Nearly 30 years ago (soon after the launch of ICD-9), the World Health Organization began working on the tenth edition of the International Classification of Diseases (ICD-10) coding system. While many other countries—Australia and Canada, for example—have already adopted the new codes, the US is set to switch on October 1, 2014. With that in mind, here are three things you should know about ICD-10:

1. All HIPAA-covered practitioners must transition from ICD-9 to ICD-10.
Today, ICD-10 consists of two code types: diagnosis or clinical modification codes (ICD-10-CM) and procedural classification codes (ICD-10-PCS). To give you an idea of scope, there are more than 68,000 ICD-10 diagnosis codes and 72,000 procedural codes. For comparison, ICD-9 has 13,000 diagnosis codes and 4,000 procedural ones. ICD-10 codes also differ in structure; they contain seven digits, and while the first three digits are similar to those of ICD-9, the additional digits that follow the decimal point communicate a greater level of specificity. For example, in diagnosis codes, the latter digits can represent laterality and whether the condition is acute or chronic.

This specificity is one of the major benefits to implementing ICD-10. In addition to replacing ICD-9, which CMS says is outdated, inflexible, and inconsistent with modern medical practice, ICD-10 allows practitioners to more specifically and exactly describe a patient’s diagnosis and classify inpatient procedures. If done right, this could improve the quality of medical data and help further evidence-based practice and interoperability—big wins for the healthcare and patient communities.

Note: HIPAA does not cover workers’ compensation or auto insurances, so you’ll continue to use ICD-9 codes for these types of claims until further notice.

2. Being prepared is the best thing you can do to ensure a smooth transition.
With the complexity of the new coding structure and the sheer magnitude of the transition, there are bound to be more than a few challenges for even the most organized clinic. So what can you do to get a leg up? Start planning. Right now, we’ve got a little less than a year until ICD-10 day, so there’s no better time to start than today. Here are a few tips:

  • Identify someone in your office to lead your clinic’s ICD-10 implementation, and start reading articles, gathering information, and watching webinars about the upcoming changes.
  • Think through your internal coding processes and determine how they’ll need to change to accommodate the new codes. Consider all of the places where you currently use ICD-9 codes (billing sheets, evaluation forms, electronic medical records, front desk cheat sheets, etc.).
  • Start conversations with your external partners to ensure that they’ll be ready to process the new codes before October 1. Don’t forget to contact your top ten insurance payers and referral sources. Doing the latter will ensure that you know ahead of time how referring physicians plan to send you the new codes.
  • Train everyone on your staff. Be sure not to overwhelm or scare anyone, but now is the time to get your team prepared for the changes ahead.
  • Test your processes, your staff’s knowledge, and your integrations. Note that many insurance companies are completing testing and will accept claims with ICD-10 codes prior to the mandatory deadline. (Remember that these claims must also have the applicable ICD-9 codes—that is, until the switch occurs on October 1, 2014.)
  • Save at least six-months’ worth of extra revenue to cover delays in reimbursements and dips in productivity.
  • Prepare, prepare, prepare. There are bound to be more than a few transitional glitches and some seriously delayed payments, so the more prepared you can be, the better.

3. There are plenty of great ICD-10 resources.
With all the information out there about how tough switching to ICD-10 is going to be, you might be tempted to panic. Before you do, know this: there are a ton of great resources available that will help you feel more confident in your understanding of the new codes as well as your transition plan. Here are a few:

There you have it: three things you should know about ICD-10. What is your clinic doing to prepare for the transition? Tell me about it in the comments below.